Vitamin A deficiency in preschool children of Recife, Northeast of Brazil

The purpose of the study was to evaluate the extent of vitamin A deficiency (VAD) among preschool children in the city of Recife, Northeast Brazil. The sample comprised 344 children of both sexes, 24 to 60 months old, in 18 public day care centres in the city of Recife, in 2007. The nutritional status of vitamin A was assessed by biochemical (serum retinol) and dietetic (vitamin A rich-food consumption) indicators and the pondo-stature status through anthropometric indicators weight-for-age, height-for-age and weight-for-height. The prevalence of hyporetinolemia (< 0.70 micromol/L) was 7.7% (IC 95% 4.88 - 11.81), which characterizes the VAD as a light-type public health problem, according to World Health Organization criteria. On the other hand, 29.6% (IC 95% 24.22 - 35.63) of children had acceptable or marginal levels (0.70 to 1.04 micromol/L) of retinol. Regarding the vitamin A rich-food intake, values below the EAR (Estimated Average Requirement) - 210 microg/ day for children of 1 to 3 years old and 275 microg/day for children of 4 to 8 years old - were 8.1% and 21.3% respectively. The prevalence of anthropometrical deficits (< -2 scores -Z) in preschool children were 2.5% for the indicator weight-for-age, 8.6% for height-for-age and 1.5% for weight-for-height. The research findings point out to the importance of institutionalization for the appropriate nutritional status of children and maintenance of adequate reserves of vitamin A. However, more studies are needed focusing on non-institutionalized preschool, or children living outside the privileged environment of public day care centres.     

Homes for the migrants: the pueblos jovenes of Lima--a study of socioeconomic determinants of child malnutrition

The family ecology of 68 preschool children attending a health care center in a pueblo joven (low-income peripheral settlement) of Lima, Perú, was investigated to determine its bearing on their nutritional status. Some of the variables studied included family income, income available to mothers, household composition, migratory history of mothers, child feeding practices and housing conditions. Nutritional status of the children was assessed through anthropometric and dietary means. Results indicated that chronic malnutrition was widespread. Breast-feeding was common, but the weaning diets had little diversity and low-caloric value. The family diet relied heavily on soups and starchy foodstuffs, and children participated fully in the family meals by the age of two. Child growth was negatively correlated with the number of preschool children and birth order, and positively correlated with income spent on water. In its turn, the children's diet was positively correlated with the income available to the mothers and the income spent on food.     

Critical analysis of the validity of arm circumference as an indicator of protein-energy nutritional status in preschool children

Arm circumference has been recommended as a useful indicator for malnutrition screening, particularly in rural areas. The great advantages of the arm circumference over other anthropometric indicators are that the measure is easily obtained in rural areas and that the method for assessing arm circumference is simple, inexpensive and rapid. In this paper the validity (specificity and sensitivity) of arm circumference is analyzed as compared to more valid indicators of nutritional status in preschool children. We conclude that arm circumference is relatively valid for detecting global malnutrition (as indicated by weight-for-age), but of limited validity when used for detecting acute or chronic protein-calorie malnutrition. Furthermore, when compared to weight-for-age in detecting populations or individuals at high risk of acute or chronic protein-calorie malnutrition, it was found that weight-for-age has a higher level of specificity and sensitivity than arm circumference. Finally, it was found that sensitivity and specificity of arm circumference vary with age, suggesting that arm circumference cannot be considered an age-independent indicator of nutritional status. It is therefore recommended that these possible limitations of arm circumference be kept in mind when used in public health programs.     

Nutritional status of Guatemalan preschool children hospitalized for acute respiratory infections

Nutritional status (weight-for-age, length-for-age, and weight-for-length) was determined in 678 children aged 0-59 months, admitted to the San Juan de Dios General Hospital in Guatemala City with signs and symptoms of acute respiratory infections. Five hundred and fifty seven (82.2%) cases were bronchopneumoniae; 62 (9.1%) were pneumoniae, and 43 (6.3%) were bronchiolitis. Five hundred and seventy (82.6%) children lived in the urban zones of the capital city and 118 (17.4%) in the municipalities of the Department of Guatemala. Deficit in weight-for-age was found in 188 (27.8%) cases, while 176 (25.9%) showed a deficiency in length-for-age. In terms of weight-for-length, 84 (12.4%) were below -2.00 standard deviations of the reference curve. The children from out of the city showed the highest proportions of malnutrition. Monitoring of nutritional status of hospitalized children with infectious diseases can provide valuable information, not only for their management, but also for parental health education.     

Rural development, household food safety, and nutrition in western Honduras

The authors studied the impact of a rural development project on household food security and nutrition. A quasi-experimental study design was used to compare the experience of members of thirteen Honduran small-holder farmers groups which had already received a year of credit and technical assistance, with another thirteen groups which had just joined the project, and thirteen control communities. All these communities were followed-up for one year (March/April 1997-March/April 1998). Farmers participating in the project showed a greater increase in maize stores than farmers in the control communities (p = 0.01), but did not increase their dietary energy consumption. There was, however, a small improvement in their dietary diversity (p = 0.01). The impact of the project on the nutritional status of under 5's was complex. The study underlined the importance of monitoring the impact of programs which may affect food and nutrition.     

Differentiation of the nutritional status of preschool children, according to socioeconomic levels, in a marginal zone

This article informs of a study carried out in an attempt to validate a new methodology to differentiate socioeconomic levels in a low income urban population group, as well as to correlate each level with the degree of malnutrition of preschool children, using the Gómez and Waterlow classifications. The socioeconomic indicators selected were: housing, main occupational activity and educational level of the head of the family, number of members per room, food expenditure per capita, per week, and ownership of a few household articles. A scale was constructed on the basis of the afore-mentioned indicators, and values were assigned on a point system, resulting in three levels: high, medium and low. Weight and height were determined in preschool children. In order to establish correlation of anthropometric data with socioeconomic levels, and to determine if such levels permitted to differentiate the degree of malnutrition, two types of nutritional classifications were used. Of the total of 187 families selected, 46 were evaluated as of high level, 72 medium and 69, low. Analysis of the weight-for-age and weight-for-height in children 24 to 47 months of age, and total preschool children, that is, from 12 to 59 months, revealed significant differences in both classifications, p less than 0.001. The authors conclude that the point scale applied to determine socioeconomic levels, was sufficiently sensitive in distinguishing the degree of malnutrition in preschool children, especially when analyzing the total population; though not significant in a few age groups, this was probably due to the reduced number of same. It is recommended that the Gómez classification be used permanently, particularly in cross-sectional surveys, and the Waterlow classification, because of its rapid diffusion in the world.     

Factors associated with infants’ and young children’s (6–23 months) dietary diversity in Pakistan: evidence from the demographic and health survey 2012–13

Background

Optimum nutrition and good feeding practices amongst infants and young children are the key determinants of growth for a healthy life. Dietary diversity is considered to be a reliable and easy-to-measure proxy variable to assess young children’s feeding practices for dietary adequacy and nutritional intake. This research aims to examine the current practices of dietary diversity amongst infants and young children aged 6–23 months in Pakistan and the various associated factors at child, maternal, household and community levels.

Methods

Secondary data analysis was performed for this research using the nationally representative dataset of the Pakistan Demographic and Health Survey 2012–13. Data on the last-born infants and young children aged 6–23 months (n?=?1102) was taken from their mothers’ interviews, who reported on their child’s consumption of 7 food groups during the 24 h immediately preceding the survey. Data was analysed, using IBM® SPSS® Complex Sample to measure the association between children’s dietary diversity and various factors at child, maternal, household and community levels through multiple linear regressions.

Results

Our research uncovered positive associations between children’s dietary diversity and other sociodemographic variables. Overall, a variation was observed in consumption of 7 food groups across the youngest, middle and oldest age-groups of children. Multivariate analysis revealed that the children’s Dietary Diversity Score (scale from 0 to 7) increases to 0.56 (95% CI: 0.18–0.94) amongst children in the middle age-group (12–17 months). Furthermore, the children who were still breastfeeding, with mothers who had a primary level of schooling and whose mothers also received information/services from lady health workers (LHWs) on maternal and child health were found to be a statistically significant predictor of infants’ and young children’s dietary diversity. Nevertheless, amongst them, the DDS had a negative association with the children’s status of still breastfeeding and mothers’ primary level of schooling, whereas it had a positive association with children being in the middle age-group and with mothers who received information/services from LHWs.

Conclusion

The dietary diversity of infants and young children aged 6–23 months has a modest, nevertheless statistically significant, relationship with sociodemographic characteristics in Pakistan. There is a need for practical efforts to change the behaviour of communities to encourage more diverse foods to promote the healthy growth of children.

     

Maternal beliefs, feeding practices and nutritional status in Afro-Colombian infants

This study describes maternal practices and beliefs on children feeding and their relationship with nutritional status of Afro-Colombian children aged 6 to 18 months. We combined ethnographic and epidemiological data. We collected information using a food frequency questionnaire. Nine focus groups and 5 deep interviews to mothers of children less than 2 years of age were performed. Our data showed a prevalence of wasting of 2.6% (< -2 SD weight-for-length) and prevalence of stunting of 9.8% (< -2 SD height-for-age). These practices are characterized by a universal onset of breastfeeding, that lasted 10 months in average, and an early introduction of complementary food (mean: 3 months). Breastfeeding is a cultural norm. Weaning is related to new pregnancy, to low milk production and to negative effects of breast process on mothers' health. Early complementary feeding and bottle-feeding are highly valued due to their positive effect on nutritional status and adaptation of children to adult-type diets. The introduction of complementary food after 4 months, the quality of the first food introduced and the diversity of complementary food predicted better nutritional status (p < 0.05). We conclude that nutritional illiteracy and mothers' erroneous beliefs result in 50% of the mothers having inadequate feeding practices. We suggest focused interventions on those beliefs limiting good practices.     

Relation of socioeconomic and environmental indicators to the nutritional status of preschool children in a community of Sierra Norte de Puebla, México

A brief discussión on "the social" approach in nutritional research is presented. The relevance that socioeconomic factors have acquired in recent years for this type of studies, is also discussed. The main purpose of our communication was to identify and validate some socioeconomic and environmental indicators and their association with the nutritional status of preschool children in a Mexican indigenous community (Sierra Norte de Puebla). A total of 89 children below five years of age were studied and classified according to their nutritional status. A socioeconomic questionnaire was applied to their parents. Results revealed ample correlation between the degree of malnutrition of the preschool child and the following indicators: housing conditions, father's main occupation, land tenure, income, etc. It is argued that the analysis of these indicators is relevant, emphasizing the importance that the combination of anthropometrical, food consumption and socioeconomic data have for detecting population groups vulnerable to malnutrition. The obtention of these indicators is therefore highly recommended, but should not imply great obstacles; on the contrary, they should be highly sensitive and easy to detect.     

Relation between food habits and nutritional status of preschool children in a rural community

Food habits in regard to the nutritional status of preschool children and their socioeconomic situation were analyzed in this research. The study was carried out in Cuetzalan, State of Puebla; all families were studied and, besides the presence of a preschool child in the home, both father and mother should also be living in the same house. Forty children considered as well nourished and 40 malnourished in the opposite case, were selected, taking the limits of the Gómez classification. In order to define socioeconomic differences between the two groups, the sample population was divided into different levels, with the following results. The socioeconomic level of the well-nourished children did correlate with a good living standard of their families; in the other case, families with a low socioeconomic status, presented more nutritional problems. A questionnaire was applied to every mother selected. This included two items: a) In the first case, we tried to assess the mother's attitude towards food habits and children's illnesses. b) In the second case, the mother's knowledge concerning pregnancy, breast feeding, feeding of the child during the first year of life, taboos, beliefs and other aspects which could be related to nutrition. On the whole, the main objective of this study was attained, because significant differences were found between these two groups. Firstly, a good relationship between food habits and good nutritional status of the children was found. Secondly, mother with well-nourished children had better food habits and better socioeconomic status than mothers having children with poor health status, and therefore, of a lower socioeconomic status.     

Dietary diversity and associated factors among beneficiaries of 77 child care centers: Central Regional,Venezuela

The aim of this study was to estimate household measure diet quality, using a dietary diversity score, and its associated demographic and socio-economic factors. One hundred fifty three households representatives of the Capital District and Miranda State belonging of seventy seven day care children centers were studied. To gather data on dietary diversity, we used the food register method, collecting data on household food availability during a month. Dietary diversity at day care centers of the Capital District was 46 foods differed from that found, in Miranda State was 39 foods (p = 0.005). Likewise it differed in beneficiaries' households of the Capital District was 33 foods compared to those in Miranda State was 25 foods (p = 0.000). There were 13 and 14 foods more between day care centers and the households in both states. State (Capital District or Miranda), money spent on food per person, households size and social level were variables that explained 28.9% of dietary diversity variation in households studied. Households in the Capital District had less members, spent more money on food, and a greater proportion were non-poor compared to those in Miranda. These factors could partially explain differences in diet quality among households in the two States. Whatever perspective studied indicates that the dietary diversity had a statistically significant difference between day care centers and households in states studied. Miranda State was more deficiency than Capital District. Higher dietary diversity reflects a better quality diet at day care centers compared to households studied.     

Helicobacter pylori infection (13C-UBT), and its relationship with nutritional and socioeconomic factors in low income school children from Valencia, Venezuela

Helicobacter pylori infection (Hp) is widely spread around the world, and it is considered one of the main causes of chronic gastritis, peptic and duodenal ulcers, and gastric cancer. Recent research has shown that it can be associated with nutritional disorders, mainly with iron and other micronutrient deficiencies. The objective of this study was to assess the prevalence of Hp infection, and infection pattern according to age, sex, nutritional status, and socioeconomic conditions in children who attended the Unidad Educativa "Valentin Espinal" in the city of Valencia. 170 children, between 3 and 14 years of age were studied to assess Hpylori infection (13C-urea breath test), age, nutritional status according to BMI and Height for age, hemoglobin (cianometahemoglobin), serum ferritin (ELISA), socioeconomic status (Graffar-Méndez-Castellano), housing conditions, number of families and of people cohabitating in the same household, and quality of services. 78.8% of the children were infected with Hp, witch was significantly correlated with age but not gender. 25.9% of the sample had undernutrition, and 46.5% were stunted. 98.1% of the families lived in poverty, and 98% of the households showed sanitary deficiencies. A mean of 6.0 +/- 2.4 persons lived in each household (range: 2-15), and an average of 3.2 person shared bedrooms. The odds of being infected were higher in those children who were stunted. Also, socioeconomic status, mother's education level, and poor hosing conditions were significantly associated to being infected. Hpylori is highly prevalent among socially and economically deprived children, and age, overcrowding, and a low education level of the mother increases the risk of being infected.     

Nutritional status, lifestyle and cardiovascular risk in lacto-ovo vegetarians and omnivore

The aim of the present study was to assess socioeconomic characteristics, dietary intake, nutritional status and cardiovascular risk (using anthropometric indicators of central obesity) in lacto-ovo vegetarians and non-vegetarians. Two non-vegetarians were selected for each vegetarian (paired for gender and age) in order to increase the power of the statistical tests. The sample was made up of 87 individuals (58.6% males; 29 vegetarians and 58 non-vegetarians) with a mean age of 40 +/- 13 years. Among the socioeconomic characteristics, only the number of residents per household differed between groups, with a greater percentage of homes with five or more residents in the vegetarian group. Concerning lifestyle, the groups differed with regard to smoking habits (p < 0.001), with a higher proportion of smokers among the non-vegetarians. There were no significant differences between groups in any of the anthropometric variables studied. Concerning dietary intake, no difference between groups was found with regard to total calorie intake, but the consumption of proteins, total lipids, saturated fat and cholesterol was higher among the non-vegetarians, whereas carbohydrate and fiber intake was higher among the vegetarians. The results of the present study suggest that, although a lacto-ovo vegetarian diet is considered healthier due to the lower consumption of total fat, saturated fatty acids and cholesterol, there are no significant differences in nutritional status or anthropometric indicators of cardiovascular risk when lifestyle and total calorie intake are similar.     

Muscle and fat indicators in boys of the upper socioeconomic strata of Caracas

A sample of 271 boys, aged four, eight and 12 years, belonging to the upper socioeconomic strata of Caracas, was studied in order to test the sensibility and specificity of arm muscle and fat indicators, as evaluators of the muscle and fat tissues development, as well as of the nutritional status. Weight, height, arm circumference and triceps skinfold were measured following standardized techniques; muscle and fat areas were calculated from arm circumference and skinfold measurements. For statistical analysis, results were compared with North American reference standards, and correlation and regression analyses were performed. Nutritional assessment was performed using weight-for-age, height-for-age and weight-for-height, arm circumference and skinfold, plus the two derived areas. Malnourished children were identified using WHO guidelines in height and weight. Prevalences were compared and the sensibility, specificity and predictive values were studied. Malnourished children were analyzed individually. Arm circumference was the best predictor of nutritional status and triceps skinfold the worst predictor; muscle and fat areas were moderate predictors. On the average, four-year olds were smaller, lighter and much leaner than the reference, and eight and 12-year olds were taller, heavier and more muscular than the reference. Low fat was most prevalent in four-year olds, while high muscle increased with age and was highest at age 12, consistent with pubertal development. Obesity was most prevalent in eight-year olds. Twenty-eight per cent of the 50 children identified as malnourished in weight and height according to WHO, were normal in muscle and fat, and 66% of the 100 identified as malnourished in muscle and fat were normal according to WHO guidelines. Furthermore, 24% of children classified as overweight by weight-for-height were not obese but high in muscle. It is concluded that muscle and fat areas reflect muscle and fat components but are poor indicators of malnutrition, expressed in terms of weight and height. On the other hand, weight and height do not measure body composition. Weight-for-height should be used in combination with muscle and fat areas. National reference standards are needed and cut-off points should be revised, in order to maximize the efficiency and predictive values of these indicators.     

Comparison in the dietary intake of preschool children, attending national daycare centres (Junji), in the eastern area of Santiago, Chile

The objective of this study was to evaluate the energy intake of obese and normal nutritional status preschoolers, from four to five years old, attending several day care centres (JUNJI), in the eastern area of Santiago. The sample comprised 85 normal nutritional status and 35 obese children, representative of a population of 450 children. The food intake was evaluated twice a week and on one weekend day. At the day care centre, food intake was measured by food weighing and at the home; it was measured by food-recording. FAO 2001 energy requirements were used to calculate the energy requirements of the children. In both obese and normal nutritional status, energy intake was similar in the educational institution and home, although this energy intake corresponds to there meals time at JUNJI and only one serving at home. In respect to energy requirements of preschool children, both obese and normal nutritional status boys are at energy balance during the week (90 versus 110%). In the corresponding female groups, energy intake exceeds their energy requirement (116 and 111% respectively). In conclusion, energy intake at home, is greater and of minor quality, situation that worsens over the weekend in all preschoolers, independently of their nutritional condition (energy adequacy > 114%).     

Serum leptin in eutrophic and overweight Venezuelan children and adolescents

Leptin is closely related to obesity and its complications. In order to determine serum levels of this hormone in children and adolescents, and its associations to age, gender, socioeconomic status, nutritional anthropometrical status and dietary intake, 166 children and adolescents (91 normal and 75 obese, aged 2 to 15 years), from low socioeconomic status were assessed. A socioeconomic evaluation (Grafffar-Mendez C method), dietary intake (24 hour recalls), anthropometrical assessment and leptin by ELISA were performed. Normal or eutrophic was defined as weight for height (W/H) or Body mass index (BMI) and fatty area between 10th and 90th percentile. Obesity when indicators were over 90th percentile. Leptin was significantly higher in obese than in normal, without differences by gender or age. Leptin percentile distribution showed 11.53 microg/L and 24.29 microg/L as 90th percentile for normal and obese children, respectively. There was a tendency to inverse correlation among leptin, fat dietary intake and waist-thigh ratio. Excessive fat intake was associated to lower serum leptin. Results suggest that obese children had leptin resistance, independently of age and gender. It is recommended to develop nutritional education programs regarding obesity and dietary intake in order to prevent and control infantile obesity.     

Imbalance diets in preschool children: study in a day-care center in the Province of Buenos Aires,Argentina

The purpose of this study was to investigate the impact of low fat diets in children aged 2 to 5. Eighty two children (40 females and 42 males) attending a school cafeteria (Province of Buenos Aires, Argentina), in a cross sectional study, were evaluated. Body weight (W), height (H) and body composition (BC) by bioimpedance were recorded. The anthropometric raw data were processed as Z-score of the weight-for-age (WEZ) and of the height-for-age (HAZ). Serum insulin-like growth factor 1 (IGF-1) and Zinc/haemoglobin ratio (Zn/Hb) were also measured. Results showed that 73.2% of the children were adequate (A) according WEZ, 13.4% were lean (L) and 13.4% overweight (O). 8.5% presented simultaneously impairment in WEZ and HAZ. Body fat percentage and energy metabolism were higher in O than in L and A (p < 0.05). Serum IGF-1's children--aged 4 to 5 years--with HAZ deficit were low than adequate HAZ ones. No statistical differences in Zn/Hb ratio between A, L and O were found. This cross sectional study suggests metabolic disorders in young children attending school cafeterias. These conclusions will allow to design balanced diets in order to optimize the resources, promote optimal growth and development and prevent adult diseases through dietary practices in childhood.     

The feeding of children in Latin America

Nutritional and dietary recommendations are given for infants, preschool and school children in Latin America, based on known and prevailing nutritional deficiencies, and on the prevention of degenerative diseases in adulthood. Special emphasis is placed on dietary iron and zinc deficiencies, as well as on the prevention of obesity and atherosclerosis, diseases which are seriously affecting medium and high socioeconomic levels of the Latin American population.